Texas Telemedicine Laws: Licensure, Prescribing, Parity

Texas is a full-license state that made itself easier to enter through the Interstate Medical Licensure Compact rather than through a telehealth registration. It writes its core telemedicine rules into statute, holds remote care to the same standard as an office visit, and has coverage parity without payment parity. The prescribing rule that catches multi-state groups: prescribing for chronic pain generally requires two-way video.

Licensure: full license, compact on-ramp

Under Occupations Code § 151.056, a person physically located outside Texas who performs an act that is part of a patient care service initiated in Texas by electronic means is engaged in the practice of medicine in Texas. The Medical Board's telemedicine rule, 22 TAC § 175.1, then closes the door that used to be open: a physician may not provide telemedicine medical services to patients in Texas without a full Texas medical license, except for physicians who already held an out-of-state telemedicine license as of September 1, 2022. That license is now a grandfathered category, not a pathway.

The statutory exceptions are narrow: episodic consultation by an out-of-state specialist with a Texas-licensed physician in the same specialty, consultation with Texas medical schools and certain UT institutions, and bordering-state physicians ordering home health or hospice services. None covers an ongoing telehealth relationship with a Texas patient.

What Texas offers instead is the Interstate Medical Licensure Compact. Texas enacted membership through HB 1616, effective September 1, 2021; the Texas Medical Board began accepting compact applications in March 2022, and the Board confirms Texas can serve as a physician's state of principal license. Texas also participates in the Physical Therapy Compact. Texas is also a Nurse Licensure Compact state and a PSYPACT participating state, but it has not joined the Counseling Compact.

One structural point: Occupations Code § 111.008 says Chapter 111 "does not apply to mental health services." That removes the statute's relationship-formation and consent provisions from mental health care, not licensure, Board rules, or the standard of care — telepsychiatry practices should read it as a narrowing, not an exemption.

Prescribing: the relationship can start online; pain has its own rule

Occupations Code § 111.005 lets a practitioner-patient relationship form by telemedicine when the practitioner meets the standard of care and uses synchronous audiovisual interaction; asynchronous store-and-forward technology, including store-and-forward in conjunction with synchronous audio interaction, paired with clinically relevant images or the patient's relevant clinical records; or another form of audiovisual technology that allows compliance with the standard of care. No prior in-person exam is required. A relationship formed that way generally carries follow-up duties, including a report to the patient's primary care physician within 72 hours, subject to the statute's conditions. The statute's list includes synchronous audio paired with store-and-forward clinical records or images, but not audio alone; confirm with the Board before opening relationships by phone.

Section 111.007 holds telemedicine to the same standard of care as an in-person visit and bars any agency from imposing a higher one by rule.

22 TAC § 175.3 requires an established relationship and compliance with all other applicable law, including the Texas Controlled Substances Act, before any dangerous drug or controlled substance is prescribed. Texas bans no schedule outright by telehealth. The Texas-specific limit is chronic pain: under 22 TAC § 175.3(b), a physician prescribing for chronic pain via telemedicine must use two-way audio and video unless the patient is an established pain patient of the prescribing physician, receives a prescription identical to the one issued at the previous visit, and was seen by the prescribing physician or their delegate within the last 90 days, in person or by two-way audio-video. Two other lines are statutory: § 111.005 states that no practitioner-patient relationship exists when a practitioner prescribes an abortifacient, and § 111.009 caps teledentistry controlled-substance prescriptions at two days for opiates and five days otherwise.

The Texas Controlled Substances Act adds duties that apply to telemedicine exactly as in person:

• Registration. Texas no longer issues a state controlled substance registration; since September 1, 2016, a DEA registration or exemption is what the state requires to prescribe (Health & Safety Code § 481.061).
• PMP. A prescriber must check the patient's record in the Prescription Monitoring Program before prescribing opioids, benzodiazepines, barbiturates, or carisoprodol. The duty does not apply to a patient diagnosed with cancer or sickle cell disease or receiving hospice care, when the prescriber notes that in the prescription record, or when a good-faith attempt to check fails for reasons outside the prescriber's control. A violation is grounds for discipline (§§ 481.0764, 481.0765).
• Opioid limits. For acute pain, a practitioner may not prescribe more than a 10-day supply of an opioid or provide for a refill. Acute pain excludes chronic pain and pain treated as part of cancer, hospice or end-of-life, or palliative care, and the limit does not apply to FDA-approved opioids prescribed to treat substance addiction (§ 481.07636).
• E-prescribing. Controlled-substance prescriptions must be issued electronically, with listed exceptions such as temporary technological failure, pharmacies outside Texas, delays that would harm the patient, and one-year waivers for economic hardship or technological limitations (§§ 481.075, 481.0755, 481.0756). Medicare Part D separately requires at least 70 percent of Part D Schedule II–V prescriptions to be electronic under 42 CFR 423.160, subject to exceptions and waivers.

Federal law adds a separate layer for controlled substances. Under the temporary rule DEA and HHS published December 31, 2025 (90 FR 61301), which runs through December 31, 2026, a DEA-registered practitioner may prescribe Schedule II–V controlled substances after a real-time audio-video telemedicine encounter without a prior in-person evaluation, when the rule's other conditions are met; audio-only encounters qualify only for Schedule III–V narcotic medications approved by the FDA to treat opioid use disorder. See our DEA prescribing report.

Consent: required by statute, formats being standardized

Under Occupations Code § 111.002, the treating physician or health professional who provides or facilitates telemedicine or telehealth must ensure informed consent is obtained from the patient, or from an authorized decision-maker, before services are provided. The Board's rule adds that complaint-notice postings must follow Chapter 111 and the Medical Practice Act.

HB 1700, effective September 1, 2025, amended § 111.004 to require every agency regulating telehealth professionals to adopt rules standardizing the format and retention of consent records for treatment, data collection, and data sharing, including provisions for consent documented in an audio-only format. Boards are implementing it one at a time — the Board of Nursing's rule took effect April 9, 2026 and allows written or documented verbal consent. Verify with the Medical Board whether the physician rule is final before locking intake forms.

Medicaid: broad modalities, home included, no facility fee at home

Texas Medicaid, run by HHSC and administered through TMHP, covers telemedicine (physician-delivered), telehealth (other licensed professionals), and home telemonitoring. Live video is billed with modifier 95; audio-only carries modifier 93 for non-behavioral services and FQ for behavioral health. Audio-only is limited to services HHSC has designated as clinically effective and cost-effective in the benefit language, and behavioral health audio-only requires informed consent before the service. The handbook treats store-and-forward mainly as a companion to audio-only encounters rather than a standalone benefit.

The patient's home is a permitted site, but the Q3014 facility fee is not payable when the home is the patient site. Consent may be written or verbal (verbal must be documented), a parent must consent before anyone else joins a child's visit, and school-based visits require advance parental consent. Home telemonitoring covers diabetes or hypertension with a qualifying risk factor and certain medically complex children, with prior authorization in up-to-180-day blocks. Managed care organizations may not deny reimbursement for a covered service solely because it was delivered remotely. Rates come from the fee schedule, not a parity statute.

Private insurance: coverage parity, not payment parity

Insurance Code § 1455.004 requires state-regulated plans to cover a covered service delivered by a preferred or contracted (in-network) health professional as telemedicine or telehealth "on the same basis and to the same extent" as the same service in person, bars excluding a service solely because it was not delivered in person or limiting coverage based on the professional's choice of platform, caps cost-sharing at the in-person amount, and prohibits a separate telehealth-only deductible or an annual or lifetime maximum beyond the plan's aggregate maximum. Chapter 1455 has no utilization review provision, and it does not apply to small employer plans written under Chapter 1501. It does not set a payment rate — Texas has no payment-parity mandate — and plans are not required to cover audio-only, text-only, or fax-only services. Section 1455.006 requires issuers to post their telehealth policies and payment practices online, though not negotiated rates — the practical starting point for modeling revenue. HB 1052 added a cross-border rule for plans issued or renewed on or after January 1, 2026: coverage is the same when either party is outside Texas, provided the patient resides primarily in Texas and the provider is licensed or otherwise authorized to provide the service in Texas and has a physical office in the state. The broader picture is in our reimbursement guide.

What to watch

Three items: the HB 1700 consent-format rules landing board by board through 2026, the physician rule especially; HB 1052's cross-border coverage rule, which will surface in 2026 plan renewals and contract language; and the federal side, where the DEA's telemedicine prescribing framework and Medicare's telehealth flexibilities change what Texas's permissive rules are worth — verify current status before building on them. The Legislature does not meet in regular session until January 2027, so state changes before then will come from rulemaking. Verify current requirements with the Texas Medical Board and HHSC before acting, and compare Texas with its neighbors in the national overview.